Irritating fictional doctors: Dr Gregory in F Scott Fitzgerald’s “Gretchen’s Forty Winks” and the balanced life

A while back I posted about the less-than-busy doctors of Victorian detective fiction. Another medical archetype of fiction is the irritatingly bluff doctor. While Dr Gregory in F Scott Fitzgerald’s short story “Gretchen’s Forty Winks” is a minor character, he encapsulates a certain cheery complacency.

This story is not among Fitzgerald’s best. An awful lot of Fitzgerald’s writing was for money, in the midst of a chaotic life. There’s nothing wrong with this – remember Dr Johnson’s dictum that no man but a blockhead writes except for money. However, “Gretchen’s Forty Winks” is no Great Gatsby. There is also much that would now be deemed sexist, not to mention casual gaslighting and slipping of Mickey Finns within the marital relationship . Of course, no doubt there is much we find unexceptional or even virtuous in our own culture which will in nearly a century seem laughably unethical.and the story has some by-the-way flashes of Fitzgerald’s acuity and brilliance. It also has some historical interest as an portrayal of what might have been seen as a “balanced life” in 1924.

The story was published in the Saturday Evening Post of March 15, 1924.

It is a rather heavy handed spoof of the cult of the “balanced life” (nowadays we would say work-life balance). The protagonist, Roger Halsey, is an advertising man, who has struck out for himself having left “the New York Lithographic Company.” We meet him coming home to his wife Gretchen. Fitzgerald writes thus of their marriage: “it was seldom that they hated each other with that violent hate of which only young couples are capable, for Roger was still acutely sensitive to her beauty.” Halsey has to work for forty solid days to obtain “some of the largest accounts in the country”, to the disappointment of his wife – “she was a Southern girl, and any question that had to do with getting ahead in the world always gave her a headache.”

His wife introduces Halsey to George Tompkins, an interior designer and devotee of the “the balanced life.” An irritated Halsey asks for a definition:

“Well’ – he hesitated – probably the best way to tell you would be to describe my own day. Would that seem horribly egotistic?”

“Oh  no!” Gretchen looked at him with interest. ‘I’d love to hear about it’

‘Well, in the morning I get up and go through a series of exercises. I’ve got one room fitted up as a little gymnasium, and I punching the bag and do shadow-boxing and weight-pulling for an hour. Then after a cold bath – There’s a thing now? Do you take a daily cold bath?’

‘No,’ admitted Roger. ‘I take a hot bath in the evening three or four times a week.’

A horrified silence fell. Tompkins and Gretchen exchanged a glance as if something obscene had been said.

‘What’s the matter?’ broke out Roger, glancing from one to the other in some irritation. ‘You know I don’t take a bath every day – I haven’t got the time.’

Tompkins gave  a prolonged sigh.

‘After my bath,’ he continued, drawing a merciful veil of silence over the matter, ‘I have breakfast and drive to my office in New York, where I work until four. Then I lay off, and if it’s summer I hurry out here for nine holes of golf, or if it’s winter I play squash for an hour at my club. Then a good snappy game of bridge until dinner. Dinner is liable to have something to do with business, but in a pleasant way. Perhaps I’ve just finished a house for some customer, and he wants me to be on hand for his first party to see that the lighting is soft enough and all that sort of thing. Or maybe I sit down with a good book of poetry and spend the evening alone. At any rate, I do something every night to get me out of myself.’

Roger is unimpressed. As the story progresses, he keeps to his exacting work schedule, until he nearly has secured a major account. Gretchen has chafed all along at the economising, and the night before a crucial submission forces another dinner with Tompkins. At this, Roger and Tompkins end up having a blazing row, simmering with the fury of the man who suspects he be becoming a cuckold:

“‘Are you implying my work is useless?’ demanded Tompkins incredulously.

‘No: not if it brings happiness to some poor sucker of a pants manufacturer who doesn’t known how to spend his money'”

SPOILER ALERT!

 

 

 

 

After ejecting Tompkins from his house, Roger resorts to obtaining something unmentioned from the local drugstore, and putting “into the coffee half a teaspoonful of a white substance that was not powdered sugar” before giving it to his wife. He also hides all her shoes in a  bag.

This allows him to spend all night working on the account (not before giving his grumpy landlord the bag of shoes as a guarantee, having missed that month’s rent) with ultimate success. A contrite Gretchen awakes after a full day going missing from her life, thanks to her husband’s deployment of white powder, and so distressed is she at finding her shoes missing that Roger agrees to take her to the doctor.  Enter Doctor Gregory, a man for whom the word ‘confidentiality’ has no meaning:

The doctor arrived in ten minutes.

‘I think I’m on the verge of a collapse,’ Gretchen told him in a strained voice.

Doctor Gregory sat does on the edge of the bed and took her wrist in his hand.

‘It seems to be in the air this morning.’

‘I got up,’ said Gretchen in an awed voice, ‘and I found that I’d lost a hole day. I had an engagement to go riding with George Tompkins -‘

‘What?’ exclaimed the doctor in surprise. Then he laughed.

‘George Tompkins won’t go riding with anyone for many days to come.’

‘Has he gone away?’ asked Gretchen curiously.

‘He’s going West.’

‘Why?’ demanded Roger. ‘Is he running away with somebody’s wife?’

‘No,’ said Doctor Gregory. ‘He’s had a nervous breakdown.’

‘What?’ they exclaimed in unison.

‘He just collapsed like an opera-hat in his cold shower.’

‘But he was always talking about his – his balanced life,’ gasped Gretchen. ‘He had it on his mind.’

‘I know,’ said the doctor. ‘He’s been babbling about it all morning. I think it’s driven him a little mad. He worked pretty hard at it, you know.’

‘At what?’ demanded Roger in bewilderment.

‘At keeping his life balanced.’ He turned to Gretchen. ‘Now all I’ll prescribe for this lady here is a good rest. If she’ll just stay around the house for a few days and take forty winks of sleep she’ll be as fit as ever. She’s been under some strain.’

Dr Gregory’s utter disregard for confidentiality is impressive in its brazenness (and if he could make a house call in ten minutes he is himself presumably impressively non-busy) but, for me, the height of his irritatingness is still to come:

‘Doctor,’ exclaimed Roger hoarsely, ‘don’t you think I’d better have a rest or something. I’ve been working pretty hard lately.’

‘You!’ Doctor Gregory laughed, slapped him violently on the back. ‘My boy, I never saw you looking better in your life.’

 

“slapped him violently on the back” – truly Dr Gregory is a prince among doctors… (the phrase also pops up in James Herriot)

As for the more general spoof of “the balanced life”, it is surely wise to reflect moderation in all things is wise, especially moderation. A suspicion of overly-programmed approaches to nature and leisure underlies my mild suspicion of “forest bathing” One of the founders of The Idler once wrote about having a breakdown due to his frenetic life of writing and talking about the wonders of idleness.

But it might also be wise to recall that Fitzgerald’s book of autobiographical writings was called The Crack-Up.

Post for CCIO blog 20/02/17 – The “technodoctor” and putting stories at the heart of healthcare

Here is a post on the CCIO blog which I guess crystallises some of the thoughts I have posted here inspired by Cecil Helman. So this marks a culmination of sorts of engagement with his work.

The “technodoctor” and putting stories at the heart of healthcare

POSTED BY SEAMUS MACSUIBHNE ON 20TH FEBRUARY 2017 POSTED IN COLLABORATION/SHARED BEST PRACTICES,EDUCATION AND TRAINING

Cecil Helman was a South African-born GP who died in 2009 of motor neurone disease. He was also an anthropologist whose textbook, Culture, Health and Illness, remains a key reference and teaching text for medical anthropology. His approach to medicine, and life, is summed up in the words of one of his obituaries:

For Cecil literature and art were as important as the science of medicine. He was fascinated by people, their cultural and ethnic backgrounds, the narratives of their illnesses, their interaction with practitioners, and the role of traditional healers in many different societies. As he said, to be an effective healer, a doctor needs to ‘understand the storyteller as well as the story’.

While his academic works have had a major influence on healthcare education and training, his most popular book was 2006’s Suburban Shaman a “mosaic of memories” of storytellers/patients and their stories, informed by his anthropological knowledge and approach. A posthumous sequel, An Amazing Murmur of the Heart, is a sort of sequel, in which Helman discusses the often-dehumanising process of medical education, during which the patient becomes something denatured, disconnected from their narrative. And in this book Helman identifies a new kind of doctor – the “technodoctor”:

Young Dr A, keen and intelligent, is an example of a new breed of doctor – the ones I call ‘techno-doctors’. He is an avid computer fan, as well as a physician. He likes nothing better than to sit in front of his computer screen, hour after hour, peering at it through his horn-rimmed spectacles, tap-tapping away at his keyboard. It’s a magic machine, for it contains within itself its own small, finite, rectangular world, a brightly coloured abstract landscape of signs and symbols. It seems to be a world that is much easier for Dr A to understand , and much easier for him to control, than the real world –  one largely without ambiguity and emotion.

Helman further identifies that this attitude marks a further step along the road of reductionism and dehumanising in medical care:

Like many other doctors of his generation – though fortunately still only a minority – Dr A prefers to see people and their diseases mainly as digital data, which can be stored, analysed, and then, if necessary, transmitted – whether by internet, telephone or radio – from one computer to another. He is one of those helping to create a new type of patient, and a new type of patient’s body – one much less human and tangible than those cared for by his medical predecessors. It is one stage further than reducing the body down to a damaged heart valve, an enlarged spleen or a diseased pair of lungs. For this ‘post-human’ body is one that exists mainly in an abstract, immaterial form. It is a body that has become pure information.

I was reminded by Robert Wachter’s speech at the 2016 CCIO Network Summer School in Leeds, on unintended consequences in health IT. He gave the example of hospitals where doctors are no longer to be found on the wards interacting with patients and other staff, but in a room full of doctors on computers, interacting with the EHR. The most stark illustration he used, however, was a child’s picture of a visit to the doctor, showing the doctor’s back turned to the child and her mother, tap-tapping away at the screen.

“A body that has become pure information” is how Helman describes the end process of the dehumanisation he decries. While I think the “technodoctor” is something of a straw man, Helman is certainly pointing to a genuine risk. “An Amazing Murmur of the Heart” is full of wisdom about the importance of connection, of physical touch, of attending to the story the patient brings, and the meaning of their symptoms for them. It would be a pity if this kind of rich, truly humanistic approach to medicine is somehow placed in opposition to the world of the “technodoctor.”

One way of avoiding the development of this false dichotomy into something tangible lies in Helman’s emphasis on the need to “understand the storyteller as well as the story.” What Helman doesn’t discuss in these passages is how paper-based information systems in healthcare can obscure the story and the storyteller in a welter of disjointed confusion. My own experience of paper notes is all too often wading through pages of confusing, if not illegible, notes, searching for something typewritten or printed. In this circumstance, the story the person is bringing to the encounter is utterly lost.

Initiatives like the EHR Personas allow for the conscientious, judicious use of narratives in planning and executing a major health IT change, one that could radically alter not only how healthcare is delivered but also how the personal story that is at the heart of all this activity is told.

Helman is, from the grave, issuing a warning, however, about what could go wrong. It is the same warning as that Bob Wachter gives with the child’s picture. It is fortunate that “narrative medicine” has become an academic subject in its own right, although perhaps this development indicates that something has been lost. In planning health IT interventions, we must ensure that they allow the story to be told and the storyteller to be heard. Let us focus on ensuring that the human stories that are the real stuff of every single clinical encounter are never lost, and that we turn our faces not to the screen but to those human stories.